Manages and identifies trends in complex business financials by evaluating capital projects, contractual arrangements, and business development opportunities; developing solutions and recommendations; defining financial reports; analyzing current data; constructing financial models and conducting financial analyses of business performance; and defining future budgets, forecasts, and appropriate action plans to correct below target results or current and future financial goals and initiatives
Partners with senior management to plan and analyze business performance by collaborating with internal and external key stakeholders for relevant information; identifying gaps between business goals and stated corporate objectives; communicating and presenting immediate and future projections, results, risks, and needs to various levels of leadership; providing feedback to senior management regarding assumed level of risk; supporting business unit budget process and strategic business plans; and providing insight on relevant historical trends, expected future events, and retail trends.
Serves as subject matter expert by educating internal teams about bill review process and system changes; providing supporting information and education related to litigation of bill review to defense attorneys; analyzing bill review litigation trends with adjusting teams legal department to develop solutions for implementation ; collaborating with third party administrators to improve processes ; drafting letters and explaining review statements for multiple states; educating team and vendor processors on pre-litigation best practices; and participating and leading special projects to enhance bill payment processes.
Manages customer service and vendor call centers by reviewing reports on call time averages to make sure calls are being processed according to company policies and procedures; ensuring timely responses to inquiries regarding pharmacy and medical billing from internal and external stakeholders ; identifying and resolving global trends on escalated issues (for example, unprocessed hospital bill complaints); establishing and maintaining relationships with customers, colleagues, and vendors; communicating with and educating customers on services provided and savings potential; conducting team meetings to discuss business practices and educate associates; and attending team meetings to build relationships, open lines of communication, and understand the impact on each department .
Oversees the continuous improvement of operational and system processes for government and commercial billing by conducting program evaluations; assessing past, current, and future parameters of programs; assessing audit requests, billing requirements, reimbursements, and formulary guidelines; engaging all required stakeholders; defining the appropriate action plan; and following up with stakeholders to ensure accuracy and completeness in the billing process.
Minimum Qualifications...Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications: Bachelor’s degree in Business Management, Accounting, Project Management, Healthcare Management , or related field and 4 years’ experience in insurance claims, accounting, or related area OR 6 years’ experience in insurance claims, accounting, or related area. 1 year’s supervisory experience.
Preferred Qualifications...Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
Working on cross-functional teams or projects
Masters: Business Administration